Individual
MARY ANTOINETTE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3029 WINTERBERRY DR, ROANOKE, VA 24018-2865
(540) 588-1807
Mailing address
3029 WINTERBERRY DR, ROANOKE, VA 24018-2865
(540) 588-1807
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119000185
VA
225X00000X
Occupational Therapist
104369
MN
Other
Enumeration date
01/08/2016
Last updated
01/08/2016
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